The man in the emergency room was dying of terminal brain cancer, unable to feed, wash and toilet himself and in constant, excruciating pain.

His wife confided in Dr. Brett Belchetz that every day at home her husband turns to her and asks, ‘Will you help me end my suffering?’

“She wanted to know if there was anything I, as a physician, could do to help,” said Dr. Belchetz, a Toronto emergency physician who treated the man last week.

“What’s frustrating is that I have nothing to offer them,” he said. “When I signed on to be a doctor I didn’t sign on to keep people alive no matter what. But I can’t do for these patients what they ask me to do.”

A new poll commissioned by an assisted-dying advocacy group suggests Canadians overwhelmingly support changing the law to allow Dr. Belchetz to perform what would now be punishable by up to 14 years in prison — actively help a dying patient kill himself.

The Ipsos Reid survey of more than 2,500 Canadians found 84% support assisted dying if strong safeguards were in place.

Described as the largest survey of its kind in Canada, the Dying with Dignity Canada-commissioned poll was released Wednesday, one week before the Supreme Court of Canada begins hearings into whether Canadians should be granted the constitutional right to euthanasia.

The survey of 2,515 Canadians found 80% of those who identified themselves as Christians — including 83% of Catholics — believe doctors should be permitted to help terminally ill patients end their lives “if they are competent and suffering” and repeatedly ask for assistance to die.

More than half of those surveyed — 57% — said they have watched someone close to them suffer a terrible death. Of those, 85% supported assisted dying.

“This is an issue, when people face it close up, they realize palliative care is not enough. If we are truly to stop the suffering we need to legalize assisted dying now,” said Wanda Morris, CEO of Dying with Dignity.

The poll found support for doctor-hastened death across every demographic, including the disabled, though the sample size was small. Of 94 people with severe disabilities surveyed, 85% were in support of medically assisted dying.

“Yet many of the people who publicly speak out against assisted dying are leaders from those communities,” Ms. Morris said.

Dr. Catherine Ferrier, a founding member of Physicians Alliance for Total Refusal of Euthanasia, has said much of the public support for assisted dying is “based on either isolated bad experiences or misinformation.”

People who wish to die “would like to co-opt both the medical profession and society into their choice, by having society sanction it and the medical profession carry it out,” she told the National Post in 2013.

“What’s the difference between someone suicidal who is young and healthy and somebody suicidal who is old and sick? The sickness is the only difference, really, and suicidality, to me, is a sign of depression until proven otherwise,” Dr. Ferrier said.

The poll comes as the Supreme Court of Canada prepares to hear oral arguments next week into whether laws banning euthanasia and doctor-hastened death violate the Canadian Charter of Rights and Freedoms. The landmark case involves two B.C. women, Kay Carter and Gloria Taylor.

In June, Quebec became the first province to pass into law historic legislation allowing terminally ill patients who are capable of giving consent the right to a doctor-hastened death to avoid “constant and unbearable” suffering.

The law is expected to come into force within 18 months, once a commission has been established to oversee application of the law.

The Ipsos Reid poll was conducted online between Aug. 21 and Aug. 29. The survey is considered accurate to within plus or minus 2.2 percentage points, 19 times out of 20, had the entire Canadian population been surveyed. However, the margin of error is larger for sub-samples, such as the disabled (plus or minus 11.5 percentage points.)

As Canada moves toward legalizing assisted suicide, our special series looks at the places it is already happening.

Last year, 77 people in Oregon swallowed lethal doses of barbiturate, made available to them under the state’s Death with Dignity Act (DWDA). Ben Wald was one of the many dozens who took their own lives with state approval, and doctors’ assistance.

The 74-year-old retired social worker had stage-four lung cancer, and two doctors agreed that he had less than six months to live. Like all prognoses, this was educated guesswork, but it satisfied the state’s assisted death requirements. As a mentally competent, terminally ill adult, Mr. Wald qualified, under Oregon’s rules, for suicide.

The bottom line, says his widow, Pam Wald, was that he “didn’t want to live uncomfortably. He was down to 118 pounds. He had a catheter. He looked in the mirror and said he looked liked someone from Auschwitz. Ben didn’t want to live that way.”

They talked about it. “He brought up assisted death one night when he couldn’t sleep,” says Ms. Wald. “It was very difficult to do, but I listened. I told him I supported him, and I said I’d be there all the way.”

The legal dose prescription cost about US$500 and was filled at a pharmacy near Portland, about two hours drive from the Walds’ home outside Philomath, a small town in central western Oregon. A family friend picked up the barbiturate capsules and delivered them.

Just one day later, with more friends gathered at his bedside, Mr. Wald consumed a bitter-tasting liquid, a mixture of water and barbiturate powder from approximately 100 capsules. He had some last words with his spouse. Within minutes he stopped breathing, and then he died.

Ms. Wald fulfilled her promise; she stuck with her husband all the way to the end. Everything had gone smoothly and according to plan. Almost.

I said I’d be there all the way

Oregon’s 19-year-old Death with Dignity Act allows terminally ill patients to obtain lethal-dose prescriptions from agreeable physicians, but not every doctor in the state is so inclined. The phrases “death with dignity” and “doctor-assisted death” were officially adopted by Oregon and written into its legislation, but critics say they’re just verbal camouflage for assisted suicide, which offends centuries of medical ethics, tradition and patient care. In Canada, the Quebec government is trying to pass its own assisted-suicide law: The province’s Bill 52, which passed second reading last month and is currently undergoing study in committee, would be the first attempt to legalize euthanasia in Canada

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Compassion and Choices, a U.S.-based charity “committed to helping everyone have the best death possible” suggests Oregon’s DWDA works flawlessly, and has enough protections built into it to remove concerns about misuse.

Compassion and Choices often refers journalists to Philomath, and to Pam Wald. She’s still grieving, but she opens her door for interviews. Now that her husband has gone, she wants to help “break down the barriers” that she says make the process more onerous than necessary.

Those “barriers” were made with best intentions, and for good reason.

No one wants a person to die involuntarily, or to be coerced into death. But the potential is always there, in any assisted-death scenario. So is the possibility of a botched attempt. With any powerful drug, things can go awry.

Oregon’s assisted-suicide process is designed to give the parties most directly involved — the dying patient, the prescribing doctor — time for sober second thought, and a second opinion. According to the DWDA, a terminally ill patient must be a mentally sound adult. The patient must make two oral requests for assisted suicide to a doctor, at least 15 days apart. Then, the patient has to make a written request, signed in front of two witnesses. Two doctors must confirm a prognosis of less than six months to live, and the patient must be advised of alternatives, such as hospice care and pain medication. Once prescribed, the lethal dose must be self-administered.

Despite its checks and limitations, the legislation barely received voter approval as a state ballot measure in 1994. Three years of legal challenges followed; in the meantime, Oregon’s own legislative assembly tried to have it repealed, without success. The DWDA was finally enacted in 1997, with just 25 licensed doctors volunteering to participate. Most were based in Portland, the state’s largest city.

We asked her for help, but she didn’t know much

The number of participating doctors has since increased. Last year, 61 physicians in Oregon wrote lethal-dose prescriptions, according to the state’s Public Health Division. The number of Oregonians dying by lethal-dose prescription has also climbed steadily, year to year, but not at the rate some had feared. In 1998, 24 people in Oregon obtained physician-prescribed lethal doses of pentobarbital or secobarbital, a sedative that’s been marketed for decades as Seconal. Last year, the figure reached 115.

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Only two of three doses are used the same year they are prescribed, typically. Some patients are known to put their suicides on hold once their prescriptions are filled; others will change their minds and throw their capsules away. Sometimes, a patient’s health will improve. Occasionally, a patient diagnosed with terminal illnesses and given a prognosis of less than six months to live will actually recover. In the worst-case scenario, a patient will ingest his lethal dose and not experience a quick or painless death. Such a case was documented last year.

Of the 115 lethal dose prescriptions made in 2012, 66 patients “ingested the medication” and died, while 23 put their prescriptions aside and “subsequently died of other causes.” Eleven patients died after ingesting lethal doses prescribed the previous year. It’s not known what 25 other patients did with their prescriptions, according to Oregon’s Public Health Division.

It reports that “one patient ingested the medication but regained consciousness before dying of underlying illness, and is therefore not counted as a DWDA [Death with Dignity Act] death. The patient regained consciousness two days following ingestion, but remained minimally responsive and died six days following ingestion.”

This is for the sickest of the sick

The Walds had always supported their state’s assisted death provisions; they both voted for the DWDA when it was introduced as a ballot measure in 1994. But in April 2012, after deciding it was time to actually engage in the process, they didn’t know where to turn.

That was the first “barrier” they encountered, says Ms. Wald. Who was available to guide them? How to find a participating doctor? Rather than go directly to a group such as Compassion and Choices for advice, they did what many in their situation would do, and visited their local hospital. They spoke with a young oncologist.

“That led to a glitch,” says Ms. Wald. “We asked her for help, but she didn’t know much about the process.” Looking back, she thinks the young specialist may have been reluctant to assist in a planned death.

“She wrote in her notes that we had not made the first required oral request to her,” says Ms. Wald. “When we went back to her, she kept saying, ‘I’m waiting for the oral request.’ But by this time, Ben couldn’t speak loudly or clearly.”

Staff at a local hospice told them about Compassion and Choices, and Ms. Wald made a phone call. A retired nurse in Eugene called back, helped the Walds fill out the required paperwork, and then put them in touch with a doctor in Corvallis, a university town about 10 miles from the Wald’s home.

Brian Hutchinson/National PostDavid Grube, an Oregon doctor who supports physician assisted death laws in Oregon, and one of two doctors who prescribed Ben Wald his lethal dose of barbituates.

David Grube was close to retirement when he met the Walds last year. A family doctor with deep roots in the local community, he had already participated in a number of assisted suicides. He’d also taken flak from other doctors, mostly people of religious faith, he suggests; those who believe the practice is antithetical to both the medical profession and God’s will.

He took part in his first assisted suicide after Oregon’s DWDA took effect. “I’d seen a lot of sick people suffer needlessly before dying,” says Dr. Grube. “A neighbour of mine shot himself. That had a profound effect on me.”

I’d seen a lot of sick people suffer needlessly

Those whom he assisted all met the state’s criteria; occasionally, he had to turn patients down. “Someone with diabetes once asked for this, and I said no,” says Dr. Grube. “This is for the sickest of the sick, malnourished and in horrible pain, not for people who are kind of sick.”

Most patients who approached him fit the norm: White, well educated, advanced in age and suffering from terminal cancer. According to Oregon’s Public Health Division, of the 673 patients who ingested “DWDA medications” from 1998 to 2011, almost 40% were between 65 and 74 years of age. Almost all of the 673 patients were white, and 71% had at least some college education. Just over 80% suffered from a malignant neoplasm, which usually means cancer. Other underlying illnesses were amyotrophic lateral sclerosis (Lou Gehrig’s disease), chronic respiratory disease, heart disease, and HIV/AIDS. Remarkably, three cases were classified as “unknown.”

Karl Maasdam for National PostPam Wald talks about her late husband Ben Wald at her home in Philomath Oregon. Ben Wald chose to die in his rural Oregon home last year, after a battle with cancer.

“Generally, in my experience, patients whom I assisted didn’t even have six months to live,” says Dr. Grube. “In some cases, they didn’t even make the two weeks required between their two oral requests.”

Dr. Grube met with the young oncologist who maintained that Ben Wald had failed to make an initial oral request. “She thought it wasn’t clear what Ben wanted,” Dr. Grube recalls. “I looked at her notes and they did make it clear. Ben wanted to die. This process was all new to her, I think, and she didn’t know what to do. I educated her, mentored her, taught her.” Eventually, the young oncologist agreed that she had, in fact, received an oral request from Ben Wald for a doctor-assisted suicide.

Live simply, act nobly, obey your heart

Fifteen days later, Dr. Grube met Mr. Wald at his home and took his second oral request. Another doctor visited and concurred with the prognosis: Mr. Wald’s condition was deteriorating and he would not live another six months under normal treatment.

There was a second “glitch,” says Ms. Wald. Under Oregon’s law, doctors and pharmacists cannot be compelled to participate in an assisted death. The Walds had their prescription, but there was no local pharmacist to fill it. A friend volunteered to make the trip up to the Portland area for the barbiturate capsules.

A dozen people arrived at the Walds’ home the following day, at the appointed hour. Ben was going to die. “It was wonderful,” says his widow. “People went into the bedroom in couples, to be with him. Friends from New Zealand sang a Maori song. Some friends read a poem.”

Mr. Wald took an anti-nausea pill; this would help him keep the poison down. The solution was mixed, and brought to him. He drank it. Husband and wife had their last words. “Live simply, act nobly, obey your heart,” he told her. And he was gone.

Ms. Wald feels certain her husband made the right choice; he’s the one who decided he wanted to die before his cancer could claim him. He followed through, before he lost his faculties.

She’s seeing a counsellor to help her through her loss. There is sadness, but no regret. “I know that some people would never have been able to do what we did,” says Ms. Wald. “It’s kind of weird, but supporting my husband through this was my last act of love to him.”

As Canada moves toward legalizing assisted suicide, our special series looks at the places it is already happening.

William Toffler is one of the few medical doctors in Oregon still concerned enough — and willing — to speak against the state’s Death with Dignity Act (DWDA), legislation that opened the door to physician-assisted death in North America when it was passed two decades ago.

Since then, most of the controversies around the law have diminished; more than 700 terminally ill patients in Oregon have used the legislation to end their lives with doctor-prescribed doses of strong sedatives. Dr. Toffler despairs. “People have become desensitized to assisted death in Oregon,” he says. Worse, “it has corrupted the practice of medicine in this state.”

Despite his high profile and his steadfast opposition to the law — Dr Toffler is a well-known professor of family medicine at Oregon Health and Science University (OHSU) in Portland, and a founder and national director of Physicians for Compassionate Care Education Foundation, a non-profit organization opposed to assisted suicide — he reckons at least 20 patients have asked him to help plan and execute their deaths.

He has always refused. Under the Oregon law, doctors cannot be compelled to participate in assisted suicide. But that doesn’t satisfy Dr. Toffler, who says that prescribing a lethal dose of barbiturate to any patient, even one suffering from great pain, is indefensible. “It’s an inherent conflict of interest for doctors,” he says. “For 2,400 years, we followed the Hippocratic tradition.”

The ancient oath has been revised over time, but the central tenet remains: Physicians may do no harm. “That’s the solid ground we stood on for centuries, and suddenly, it’s gone? We should be helping people live well with dignity,” says Dr. Toffler, “not helping them to die.

“The notion that when a doctor prescribes a patient a lethal dose of Seconal [barbiturate] he’s somehow personally invested in that person, is specious. That’s apathy. It raises questions in the minds of patients about the motivation of their doctors.”

Tough words, and seldom heard anymore in Oregon, where the majority of laypeople have moved on. But the majority of people don’t practice medicine or deal with patients. They’ll never be asked to assist with someone’s suicide.

The best advice for everyone, says Dr. Toffler, is not to consider it at all.

Late last month, he was conducting in-patient service at the OHSU hospital, the largest in Oregon. He checked on a patient named Theresa, who has cancer. “She and her husband inquired about assisted suicide,” says Dr. Toffler.

“Her husband was pushing hard for it. Theresa had surgery a month earlier and there was very little evidence of persistent cancer. There was a little in her pelvis, but she was certainly not dying. But she thought she was.”

Dr. Toffler says he spent two-and-a-half hours with Theresa. He conducted a thorough examination, something “many of my colleagues would not have done,” he says. “And I had a profound effect on her, simply by reflecting back on her worth. Two days later, she felt like she’d had an epiphany, based on my interaction with her. She was in tears She’d changed her mind, and now she wants to travel. My hope for her is that she continues to receive proper care, and that when she dies, she dies naturally, with dignity.”

Although Oregon’s assisted suicide law requires doctors to advise patients of alternatives, such as hospice care and pain management, Dr. Toffler worries that some are shirking or ignoring the responsibility. “Some think the solution to suffering is to end the life of the sufferer. That may be well-intentioned, but it’s wrong.”

The law also stipulates that a patient in Oregon must be terminally ill with less than six months to live in order to qualify for doctor-assisted suicide. But there’s no way to predict remaining life expectancy with any degree certainty, even for a patient with advanced-stage cancer.

“Anyone who says he can make a clear prognosis of six months or less, or longer, is just a soothsayer,” says Dr. Toffler.

Dr. Toffler’s critics often note that he’s a Roman Catholic, as if his religious faith directs his professional judgment. “The fact they keep bringing it up just shows their bigotry,” he argues. “I don’t bring it into the debate. They do, because they can’t use logic. They turn themselves into pretzels whenever they try.”

Yet the issue is intensely personal for him. Dr. Toffler’s wife has metastatic cancer, and a tumour in her uterus. “There are no magic tools in the toolbox to cure it,” he says. “So she takes a drug and we hope that it will slow the cancer down a little, until the cancer finds a way to get around it.”

Three or four years ago, she was told she had nine more months to live. What might have happened had she heeded advice from advocates of assisted suicide? She didn’t, says Dr. Toffler, and so she carries on, enjoying life as best she can, with her husband, their seven children, and a ninth grandchild on the way. She manages. “So if she dies without suicide,” he asks, “will it mean she did not die with dignity?” His question is rhetorical, of course, and it applies to everyone. “The fact is,” says Dr. Toffler, “we are all terminal.”

From The New YorkDaily News
A Massachusetts ballot question that would have let terminally ill patients end their lives with physician-assisted suicide was narrowly defeated Tuesday.

Some 51% of voters rejected the measure, called Question 2, which would have allowed doctors to prescribe lethal doses of medication to those with only six months to live.

“For the past year, the people of Massachusetts participated in an open and honest conversation about allowing terminally ill patients the choice to end their suffering,” the Death with Dignity campaign said in a conceding statement.

“The Death with Dignity Act offered the terminally ill the right to make that decision for themselves, but regrettably, we fell short.”